The prospective study, which ran from January 2011 to January 2015, included the respondents who were treated from various non-tumor breast changes and breast tumors. The respondents were divided into 2 groups. First one, group A (280 respondents), consisted of the respondents who are residing in the rural area. Second one, group B (343 respondents), consisted of the respondents who have residence in urban area. The aim is to analyze the attitude to non-tumor diseases and breast tumors by women of rural and urban environment. The observed parameters are the reasons for coming to the breast examination: palpable formation in the breast, regular examination, breast pain, breast swelling and other changes. Parameters to compare the results were time intervals from the detection of palpable formations to examination. There was no statistically significant difference in inflammatory diseases of the breast, except in the case of breast abscess formation which is more common in the group A. A statistically significant difference among the groups was not found in the incidence of benign and / or malignant tumors of the breast, neither. It turned out that immediately after tumor detection by palpation, 4 patients in group A went to examination the next day. Patients in group B went 3 times more often to examination after a few days of the initial palpation of the tumor than patients in group A. There are much more women in group A who after only one year from the moment of palpable formation came to examination. The number of women, who have come to examination after a few months and / or years, is almost identical. Patients in group A have less responsible attitude towards non-tumor diseases and breast tumors, so it is possible for this group to be in higher degree of risk of late diagnosis of malignant tumors.

Waldenström's macroglobulinemia is a distinct clinicopathologic entity defined as a B-cell neoplasm characterized by lymphoplasmacytic infiltrate in the bone marrow, with an associated immunoglobulin (Ig) M paraprotein. Clinical manifestations are due to deposition of IgM in the liver, spleen, and/or lymph nodes, so it presents with anemia, hyperviscosity, lymphadenopathy, hepatomegaly, splenomegaly and neurologic symptoms. The main diagnostic criteria are a typical peak on serum protein electrophoresis and malignant cells in bone marrow biopsy samples. There is no standard therapy for the treatment of symptomatic Waldenstrom's macroglobulinemia and no agents have been specifically approved for this disease, but initial treatment usually starts with the monoclonal anti-CD20 antibody rituximab, either alone or in combination with other agents, rather than chemotherapy alone. This article confirms that, despite the existence of more modern imaging methods, ultrasonography still has a significant diagnostic role.

Results of a large amount of research show that adolescents are not sufficiently informed when it comes to reproductive health. The aim of this paper was to investigate how well informed adolescents in the Republic of Srpska were about reproductive health and what their attitudes towards it were. The research was designed as a cross-sectional study which included 683 adolescents - 562 12 years old and 121 15-year-old adolescents from eight regions in the Republic of Srpska. The data on pupils’ knowledge of and attitudes towards reproductive health was collected through a questionnaire – survey which pupils completed individually in the presence of trained interviewers, who were available in case of difficulties with understanding questions. Methods of Descriptive Statistics were used to describe the sample in question, and the χ 2 test was used to determine statistical significance of differences in age. By analyzing the awareness of the 12-year-olds and 15-year-olds, it was found that there was a statistically significant difference in the distribution of answers to the following questions: What is puberty? (χ 2 =8.050; p<0.01), What is menstruation? (χ 2 =11.935; p<0.01), What is conception? (χ 2 =22.974; p<0.01), What is abortion? (χ 2 =8.851; p<0.01). According to this research, every fourth 12-year-old and eighth 15year-old received information on reproductive health from their parents. Most young people (54.9%) would ask their parents for advice on solving sexual life issues, while only 2.8% would ask their teacher. Every fourth adolescent would ask their peers for advice on solving sexual life issues. Out of all adolescents that took this survey, 79.1% think that it would be useful to have Sexual Education as a school subject. Results of this research indicated the need for more intense implementation of education programmes in the field of reproductive health among adolescents in the Republic of Srpska. Acta Medica Medianae 2013;52(1):9-15.

Primary bilateral iliopsoas abscesses in the elderly are very rare in Europe. We report a case of an elderly male misdiagnosed with rheumatic low back pain. The delay in accurate diagnosis and therapy led to severe worsening of his general condition and septic shock. The diagnosis was established by multi-slice computed tomography (MSCT) and the patient was successfully treated by MSCT-guided percutaneous drainage of both psoas muscles. Septic shock and miscellaneous complications required continuous intensive care. The patient was discharged after 42 days of hospital treatment. Antibiotic therapy continued for the next six weeks until his complete recovery. Pain remains the most frequent and predominant symptom of spinal pathology regardless of the etiology. Immunocompromised patients or signs suggestive of bacterial infection require caution and a more comprehensive diagnostic work-up.

Introduction: Timely diagnosis is a prerequisite for the successful treatment of malignant skin tumors. Late diagnosis leads a patient into a situation of losing valuable time and chance for cure. Material and methods: A prospective study was conducted from February 2006 until August 2011 which analyzed the reasons that led to establishing the diagnosis of malignant skin tumors in 220 patients. Patients were divided into two groups: Group A (102 patients), patients with diagnosed melanoma, and group B (118 patients) of patients suffering from basocellular (BCC) and planocellular cell (PCC) skin cancer. Parameters for comparison of analysis results were the reasons for coming to examination and reasons for not coming to the examination, because of which skin cancers were not diagnosed in time. Goal: To determine the factors that influences the establishment of late diagnosis and treatment of skin tumors. Results: It was confirmed that the prejudices of patients that tumors of the skin „should not be operated because it is dangerous“ is the main reason for late diagnosis. At the same time it is confirmed that the belief that it is unnecessary to operate congenital changes of the skin is the second most important reason for delayed diagnosis of malignant skin tumors.

INTRODUCTION Basocellular skin carcinoma (BCC) is the most common cancer in the human population. BCC almost appeared at adult's people, but it can be found at children, too. THE AIM The aim of this study was to determine which the position of BCC on the head skin is the most difficult for the treatment and what the reasons are for it. METHODS With the prospective study, from June 2004 to June 2011, were compared the results of treatment of basocellular carcinomas (BCC) of the head skin. The examinees were divided into 3 groups. The first group, the group A (38 patients) was consisted of examinees treated of BCC on the nose. In the second group, the group B (42 patients) was classified of examinees treated of BCC on the face, temple, eyelids and forehead, while the third group, group C (35 patients) was classified of examinees treated of BCC on the scalp. The parameters for comparison the results of treatment were the method of treatment, number of the relapse, elapsed time from surgery to relapse and consequently defacement. RESULTS There was found a statistical significant difference in terms of choice of methods of operative treatment for the significantly higher number of operations on the scalp operated with cutaneous transplants. It was confirmed that the localization of the tumors on the scalp, and then on the nose are with the highest incidence of the relapse, whereas the postoperative defacement is mostly on the scalp after skin graft placement. Key

Association of Gastroenterologists and Hepatologists of Bosnia and Herzegovina based on the experiences of domestic and foreign centers operating in the field of hepatology and accepted guidelines of the European and the U.S. Association for Liver Diseases adopted the consensus for the diagnosis and treatment of chronic viral hepatitis B and C. The guidelines are intended for specialists in gastroenterology and hepatology, and infectious diseases physicians working in primary health care and family medicine, but also other physicians who are confronted with this disease in their practice, with the aim of facilitating and shortening the diagnostic and treatment protocols of patients with chronic viral hepatitis B and C. This ensures faster, more efficient, more rational and cost-effective care of patients with hepatitis, with an emphasis on stopping the deterioration of liver disease to liver cirrhosis and eventually hepatocellular carcinoma. Key words: Chronic hepatitis B and

Isolated splenic metastasis arising from a colorectal carcinoma is a rare finding. We report a case of 74-year-old man with a medical history of diabetes type II and paroxysmal atrial fibrillation, who underwent a right hemicolectomy for an adenocarcinoma of caecum in August 2004. In June 2007 the patient was diagnosed with high grade aortic valve stenosis as well as long segment stenosis of the first obtuse marginal branch of left coronary artery. He was suggested aortic valve replacement with coronary artery bypass grafting but he refused the surgery. In October 2007 the patient underwent alpha 18FDG - PET scanning, due to increasing values of CEA serum level, which showed a 5 cm big isolated hypermetabolic lesion in the spleen. Due to operative risk, splenectomy was refused by surgeons. The patient underwent a chemotherapy with capecitabine in total of 8 cycles before his CEA level began to rise and MSCT showed a progression in size of splenic metastasis. The patients condition was reevaluated by a team of experts and splenectomy was performed in September 2008. In May 2009 during the postoperative follow up, MSCT scanning revealed enlarged lymph nodes in celiac region and hepatic lesion suspicious of metastasis and the patient was admitted for further chemotherapy treatment. There is still no standardized treatment for this condition due to small number of cases reported in literature. Splenectomy followed by chemotherapy seems to be an optimal treatment but still no final conclusions can be made.

Horseshoe lung is a rare congenital pulmonary anomaly in which the caudal and basal segments of the left and right lungs are joined together behind the pericardium at the height of cardiac apex. Most patients with horseshoe lung have many other cardiovascular anomalies typical of the scimitar syndrome or the hypogenetic right lung syndrome. We report on a patient with horseshoe lung not associated with scimitar syndrome, but presented with a focal diaphragmatic herniation of the liver, such as never reported before in case of horseshoe lung without associated scimitar syndrome.

Annular pancreas is a rare embryonal abnormality. Its manifestation in adulthood is often pinpointed with a substantial delay, which is most often attributed to pancreatitis, biliary pathology or dyspepsia. We present a case of a 28-year-old woman who had exacerbating symptoms of high bowel obstruction from 20th week of pregnancy, progressing after premature delivery. Diagnostic work-up revealed partial annular pancreas compressing the duodenum. Despite attempts of conservative treatment, her state deteriorated to such an extent that surgery was indicated and gastrojejunal bypass created. Her postoperative recovery was uneventful. In cases in which symptoms of high bowel obstruction in pregnancy persist and prostration occurs, we suggest close monitoring and a more thorough diagnostic approach. The question remains whether annular pancreas presents a cause of pathologic findings, a cofactor, or a mere accidental diagnosis in the development of superposed pathologies.

An extremely rare case of seminal vesicle cyst associated with ipsilateral renal dysplasia and ectopic ureter is presented. A 36-year-old patient underwent nephroureterovesiculectomy. Considering the clinical and imaging profile of the patient, a diagnosis of ureterocele with megaureter was initially suspected, but intraoperative findings and definitive pathological analysis of the specimen revealed right renal dysplasia with ectopic ureter opening into seminal vesicle cyst. The clinical and therapeutic peculiarities of this rare condition are presented and the literature on this topic is reviewed.